Distress Intolerance Research Articles

Tobacco cigarette smokers who endorse greater intolerance for nicotine withdrawal also report more severe insomnia symptoms.

It has been suggested that nighttime nicotine withdrawal may help to explain why tobacco cigarette smokers are more likely than nonsmokers to experience clinically significant insomnia. There is also reason to believe that intolerance for withdrawal symptoms could play a role in withdrawal-related sleep disturbance. However, we are not aware of any previous research that examined whether smokers who endorse greater intolerance for smoking abstinence also report greater difficulty initiating and/or maintaining sleep. To address this question, 224 adult cigarette smokers (42.9% female, Mcigarettes per day = 21.3) completed the baseline portion of an experimental study that included assessment of current/historical smoking behavior, perceived intolerance for smoking abstinence, and insomnia severity and impact on functioning. The results indicated that, after accounting for general distress intolerance and sociodemographic factors, smokers who endorsed greater intolerance for nicotine withdrawal also reported greater insomnia severity and impact. Logistic regression further revealed that, for every 1-point increase in nicotine withdrawal intolerance scores, smokers were nearly twice as likely to score above threshold for clinically significant insomnia (p = .001). Collectively, these initial findings suggest that intolerance for nicotine withdrawal may warrant consideration as a potentially modifiable mechanistic factor in comorbid insomnia and nicotine/tobacco dependence. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychological predictors of treatment adherence among patients with diabetes (types I and II): Modified information-motivation-behavioural skills model.

Non-adherence to medical regimens among patients with diabetesis a well-recognized concern in health care. Modified information, motivation, behavioural skills (IMB) model by adding an emotion component to it was tested to explore predictors of treatment adherence among 1,125 Iranian patients with diabetes type I (T1D) and type II (T2D) and due to other medical conditions. The modified IMB model explained 35% of the treatment adherence with large effect-sizes f2 = 0.56 to 0.69. Self-compassion and interpersonal communication between staff and patients (ICSP) were significant predictors of treatment adherence among patients with T1D, T2D and diabetes due to other medical conditions, while both outperformed the other significant predictors of treatment adherence, i.e., illness perception and social support in all groups. Distress intolerance was a significant predictor of treatment adherence only in patients with T2D. In addition, patients, based on their type of diabetes, exhibited different patterns of illness perception in predicting treatment adherence. Among T2D patients and those with diabetes due to other medical conditions, gender (male; only in T2D) and being single were significant predictors of treatment adherence, while age and diabetes duration were not. Finally, the model demonstrated that above and beyond demographic features, self-compassion, interpersonal communication between patients and health care staff, distress intolerance, perceived social support and illness perception were significant predictors of treatment adherence among patients with diabetes.

Increased Risk Perception, Distress Intolerance and Health Anxiety in Stricter Lockdowns: Self-Control as a Key Protective Factor in Early Response to the COVID-19 Pandemic.

Studies provide evidence that distress, (health) anxiety, and depressive symptoms were high during the first weeks of COVID-19 lockdown restrictions, decreasing over time (possibly due to individuals’ protective psychological factors). Relations between different lockdown restrictions, mental health issues, and protective factors need to be explored, since even small lockdown effects might increase the risk of future mental health issues. We merged objective lockdown stringency data with individual data (N = 1001) to examine differences in lockdown effects in strict lockdown (Romania) and mild lockdown (Hungary) conditions between March and May 2020 on stressors and mental health symptoms, taking protective factors into account. The stricter lockdown in Romania revealed higher levels of perceived risk of infection, distress intolerance, and COVID-19 health anxiety. Protective psychological factors were not affected by the lockdown measures. Surpassing psychological flexibility and resilient coping, self-control proved to be the most promising protective factor. It is recommended that future research merge objective data with study data to investigate the effects of different COVID-19 lockdown measures on mental health and protective factors. Policy decisions should consider lockdown-dependent consequences of mental health issues. Intervention programs are suggested to mitigate mental health issues and to strengthen peoples’ protective psychological factors.

A pilot study of benzodiazepine cue-induced craving

ObjectivesThe misuse of benzodiazepines is a growing concern due to increases in both access to these medications and their associated public health harms, most concerningly risk for overdose when combined with other substances. Although cue reactivity—the subjective and physiological response to cues or reminders of substance use—has been identified for most major classes of substances, it has yet to be studied with benzodiazepines. In this preliminary study, our objective was to assess whether images of benzodiazepines were associated with greater craving and anxiety than neutral images in adults who reported misuse of benzodiazepines. MethodsWe recruited a sample of 38 adults from a substance use disorder treatment setting and administered a standard cue reactivity task using pictorial images along with a battery of self-report measures. ResultsResults indicated significantly higher craving and anxiety in response to benzodiazepine relative to neutral cues, with cues eliciting a moderate to high level of craving, on average. Craving was associated with several risk factors for benzodiazepine misuse, including insomnia and distress intolerance. ConclusionsThis preliminary study suggests that benzodiazepine cues can become conditioned to elicit craving responses and that the degree of cue reactivity is correlated with known risk factors for benzodiazepine misuse.

Understanding the relationship between distress intolerance and problematic Internet use: The mediating role of coping motives and the moderating role of need frustration.

There is emerging research interest in exploring the relationship between distress intolerance and problematic Internet use, yet most of the existing studies are limited by cross-sectional design, convenience sampling method, and poor understanding of the potential mediating and moderating factors involved. Based on the distress intolerance theory of addictive behavior and the theory of compensatory internet use, this study investigated a moderated mediation model to explain the impact of distress intolerance on problematic Internet use in adolescents. A three-wave longitudinal survey was conducted with 709 adolescents in Shanghai, China. The gender distribution was even, 50.2% were boys and 49.8% were girls. The mean age at T1 was 14.79 years (SD = 2.87). Distress intolerance at Time 1 was found to positively predict problematic Internet use at Time 3. This prospective relation was mediated by adolescents' coping motives for Internet use at Time 2. Further, the mediation effect of coping motives for Internet use was moderated by need frustration at Time 2. The moderated mediation model was statistically equivalent for both genders. Findings of this study contribute to new knowledge and have practical implications for prevention and intervention of adolescent problematic Internet use.

Development and preliminary validation of a scale to assess physicians' emotional distress intolerance in end-of-life care communication.

End-of-life care (EOLC) communication is beneficial but underutilized, particularly in conditions with a variable course such as chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF). Physicians' emotional distress intolerance has been identified as a barrier to EOLC communication. However, studies of emotional distress intolerance in EOLC have largely relied on anecdotal reports, qualitative data, or observational studies of physician-patient communication. A free-standing measure of multiple dimensions of distress tolerance is warranted to enable the identification of individuals experiencing distress intolerance and to facilitate the effective targeting of interventions to improve distress tolerance. This study provides preliminary data on the reliability and validity of the Physician Distress Intolerance (PDI) scale. We examine potential subdimensions of emotional distress intolerance. Family medicine and internal medicine physicians completed the PDI, read vignettes describing patients with COPD or CHF, and indicated whether they initiated or delayed EOLC communication with their patients with similar conditions. Exploratory and confirmatory factor analyses were performed on separate samples. Confirmatory factor analysis confirmed that a three-factor solution was superior to a two- or one-factor solution. Three subscales were created: Anticipating Negative Emotions, Intolerance of Uncertainty, and Iatrogenic Harm. The full scale and subscales had adequate internal consistency and demonstrated evidence of validity. Higher scores on the PDI, indicating greater distress intolerance, were negatively associated with initiation and positively associated with delay of EOLC communication. Subscales provided unique information. The PDI can contribute to research investigating and addressing emotional barriers to EOLC communication.

Situational uncertainty interacts with anxiety sensitivity and distress intolerance to predict anticipated worry and preparation for a hurricane

ABSTRACT Background There is evidence for the impact of emotional intolerance on reactivity to stressors, but it is unknown whether the level of situational uncertainty may moderate this relationship. We examined whether situational uncertainty moderated the relationship between emotional intolerance and anticipated anxious responding to hurricane forecasts, considering three aspects of emotional tolerance: anxiety sensitivity, distress intolerance, and hurricane-specific distress intolerance. Methods Participants (N = 358) were Florida residents who experienced Hurricane Irma. Participants were presented with two hypothetical storm forecasts that varied in level of uncertainty: 5-day forecast (high uncertainty) and 3-day forecast (low uncertainty). Participants rated their anticipated worry and preparation for each forecast. Results Significant interactions between forecast uncertainty and both anxiety sensitivity and hurricane-specific distress intolerance emerged on anticipated worry, such that there was a stronger relationship in the high uncertainty condition. Forecast uncertainty also moderated the relationship between anxiety sensitivity and anticipated preparation in the same direction. There were no significant interactions between forecast uncertainty and distress intolerance on either anticipated worry or preparation. Conclusions Specific aspects of emotional intolerance appear to have a stronger influence on anticipated worry and preparatory behavior in high uncertainty situations. These findings suggest that distinct emotional tolerance factors may influence these responses.

Cancer patients attending treatment during COVID-19: intolerance of uncertainty and psychological distress.

PurposeThe COVID-19 pandemic presents specific challenges for cancer patients attending oncology treatment. Using a mixed-methods design (convergent parallel design), we aimed to assess the experience, perceptions, and reactions of cancer patients during the COVID-19 pandemic.MethodsParticipants were cancer patients receiving treatment at the hospital during the pandemic (July to August 2020). In study 1, 95 participants filled out a questionnaire measuring COVID-19 experiences and perceptions, psychological distress, and intolerance of uncertainty. In study 2, in-depth interviews were conducted with 10 cancer patients, probing their experience during the COVID-19 period.ResultsMost participants experienced the COVID-19 pandemic as a major threat that would affect future health, most attended all or most of their scheduled treatments, and their mean level of psychological distress was low. A mild decrease in social support was reported, and remote contacts and support from the community had not compensated for decreased person-to person contacts. In addition, intolerance of uncertainty was related to higher psychological distress, which was partially mediated by perceptions of threat. The analysis of in-depth interviews strengthened the quantitative findings by elucidating the experience of fear of contagion alongside determination to continue treatment.Conclusions and Implications for Cancer SurvivorsThe mixed-methods design enabled us to examine the responses of cancer patients attending treatment. The findings suggest that in times of extreme uncertainty such as COVID-19, health experts need to screen cancer patients and survivors for emotional and instrumental support needs and identify patients and survivors with high intolerance of uncertainty as a risk factor for psychological distress.

Targeting maladaptive reactivity to negative affect in emerging adults with cannabis use disorder: A preliminary test and proof of concept

IntroductionCannabis use disorder (CUD) is a growing public health concern, and is highly comorbid with negative affective conditions such as anxiety and depression. Late adolescence and early adulthood represents a time of rapid emotion regulation development, as well as the onset of anxiety, mood, and substance use disorders, especially CUD. Maladaptive cognitive, behavioral, and emotional responding to one's own negative affect (in an effort to eliminate it) is associated with substance use, and represents a novel treatment target to improve outcomes of treatment for substance misuse. Method: After development of a manual for a novel intervention, Affect Management Treatment (AMT) for CUD, a pilot randomized clinical trial was conducted in 18–25 year-old participants with CUD to evaluate the impact of this approach on negative affect, constructs (e.g., distress intolerance) representing maladaptive reactivity to negative affect, and cannabis use. Participants (N = 52) received either 12 sessions of standard cognitive behavioral therapy (CBT) for CUD or 12 sessions of AMT and were assessed on measures of negative affect, reactivity to negative affect, cannabis use, and cannabis use problems at baseline, throughout treatment, post-treatment, and 6-mo follow-up. Results: AMT outperformed CBT in reducing negative affect and reactivity to negative affect, and it had a significant impact on cannabis use and cannabis use problems. There were no statistically significant between-group differences on cannabis outcomes. Conclusions: AMT offers a novel, successful approach to the treatment of CUD.

The association of distress tolerance and mindful awareness with mental health in first responders.

Mindful awareness (MA) and distress tolerance are emerging as robust predictors of mental health in populations with high levels of stress and trauma exposure, such as first responders. The combination of both protective factors may have potentiating benefits for mental health. First responders might especially benefit from high levels of MA if they are able to tolerate distressing present-moment experiences as needed. In this study, cross-sectional data were used to test whether distress intolerance (DI) moderated the relationship between MA and mental health. First responders (N = 176) completed an online assessment battery including measures of MA (Mindful Attention Awareness Scale), DI (Distress Intolerance Index), and mental health outcomes (i.e., Depression, Anxiety, and Stress Scale; Posttraumatic Stress Disorder [PTSD] Checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th edition [DSM-5]; Secondary Traumatic Stress Scale; abbreviated Maslach Burnout Inventory; compassion satisfaction subscale of the Professional Quality of Life Scale; Satisfaction with Life Scale; and Brief Resilience Scale). Multiple regression models demonstrated that among first responders with higher DI, MA had a stronger association with lower anxiety and depression symptoms. Interactions between MA and DI were not significant for other outcome measures. However, higher MA and lower DI each independently predicted lower stress (lower posttraumatic stress, secondary traumatic stress, and general stress); higher MA independently predicted better occupational health (lower burnout and higher compassion satisfaction); and lower DI independently predicted positive mental health (greater resilience and life satisfaction). Results highlight the independent associations of high MA and low DI with first responders' mental health and underscore the importance of studying of interventions that promote both of these protective factors in first responders. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Supplemental Material for Impact of a Computerized Distress Intolerance Intervention on Electrocortical Reactivity to Cannabis and Threat Cues: A Randomized Controlled Trial

Supplemental Material for Impact of a Computerized Distress Intolerance Intervention on Electrocortical Reactivity to Cannabis and Threat Cues: A Randomized Controlled Trial

Association of emotion reactivity and distress intolerance with suicide attempts in U.S. Army soldiers.

Emotion reactivity (ER) and distress intolerance (DI) may be associated with increased suicide attempt (SA) risk among U.S. Army soldiers. In this case-control study, 74soldiers recently hospitalized for SA (cases) were compared with 133 control soldiers from the same Army installations selected based on either propensity score matching (n = 103) or reported 12-month suicide ideation (SI) (n = 30). Controls were weighted to represent the total Army population at the study sites and the subpopulation of 12-month ideators. Participants completed questionnaires assessing ER, DI, and other psychosocial variables. Logistic regression analyses examined whether ER and DI differentiated SA cases from the general population and from 12-month ideators before and after controlling for additional important risk factors (sociodemographic characteristics, stressors, mental disorders). In univariate analyses, ER differentiated SA cases from both the general population (OR = 2.5[95%CI = 1.7-3.6]) and soldiers with 12-month SI (OR = 2.5[95%CI = 1.3-4.6]). DI also differentiated cases from the general population (OR = 2.9[95%CI = 2.0-4.1]) and 12-month ideators (OR = 1.9[95%CI = 1.1-3.5]). These associations persisted after controlling for sociodemographic variables, stressors, and mental disorders. Findings provide evidence that higher ER and DI are associated with increased risk of SA among soldiers, even after adjusting for known risk factors. Prospective research with larger samples is needed.

The effectiveness of marital adjustment training on couples distress intolerance, difficulty in emotion regulation and marital conflict referring to counseling centers

Introduction: Distress intolerance, difficulty in emotion regulation, and marital conflicts affect the quality of the couples life. Aim: The present study investigated the effectiveness of marital adjustment training on couples distress intolerance, difficulty in emotion regulation, and marital conflict. Method: The present study was a quasi-experimental study with a control and experimental group. The study sample included 30 couples referring to counseling centers in 2019-2020 that were divided randomly in two experimental and control groups. Afterward, marital adjustment training was provided to the experimental group during eight sessions, and the control group did not receive any intervention. Simmons and Gaher distress tolerance questionnaires, Grotz and Roemer difficulty in emotion regulation, and Sanai and Barati marital conflicts were used in this study. The data were analyzed by covariance using SPSS software version 22. Results: The results showed marital adjustment training was effective on reducing distress intolerance (f=142.76 and P<0.01), the level of difficulty in emotion regulation (f=146.94 and P<0.01), and marital conflicts (P<0.01 and f=426.21). Accordingly, distress intolerance, difficulty in emotion regulation, and marital conflict were significantly reduced in the treatment group compared with the control group who did not receive any intervention. Conclusion: The findings indicated that marital adjustment training could be an effective intervention in counseling centers for couples with communicative problems.

Emotion Reactivity and Suicide Ideation Among Chinese Adolescents: A Longitudinal Serial Mediation Model

Objective Previous studies have indicated that emotion reactivity is an important predictive factor for suicide ideation. However, the mechanism underlying their association has remained largely unexplored. The current study aims to investigate a serial mediation model to examine the potential mechanism in the relationship between emotion reactivity and suicide ideation. Method A total of 5,423 Chinese adolescents (52.7% females, Mage = 14.63 years, SD = 1.25) completed self-report questionnaires regarding emotion reactivity, suicide ideation, distress intolerance, and depressive symptoms. Assessment was conducted for two waves, 6 months apart. Results In descriptive analyses, the prevalence of suicide ideation in this study was 15.3% for Wave 1 and 14.3% for Wave 2. Emotion reactivity, distress intolerance, and depressive symptoms were positively related to suicide ideation. In serial mediation analyses, there was a significant total effect of emotion reactivity on suicide ideation. After controlling for baseline variables, distress intolerance and depressive symptoms played serial mediating roles in the relation between emotion reactivity and suicide ideation, with emotion reactivity influencing suicide ideation through three mediation pathways. Conclusions This study demonstrates a potential mechanism underlying the path from emotion reactivity to suicide ideation. Interventions that target emotion reactivity may be an effective way to reduce the risk of developing suicide ideation. HIGHLIGHTS Emotion reactivity was positively related to suicide ideation. Distress intolerance and depressive symptoms mediated the relationship between emotion reactivity and suicide ideation. Emotion reactivity also exerted an influence on suicide ideation through serial mediation of distress intolerance and depressive symptoms, after controlling for baseline variables.

Posttraumatic stress and substance use among military veterans: Associations with distress intolerance and anxiety sensitivity

The co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is highly prevalent among military veterans and represents a difficult-to-treat comorbidity. Distress intolerance (DI; i.e., the perceived inability to tolerate negative emotional states) and anxiety sensitivity (AS, i.e., the fear of anxiety-related sensations) are two promising targetable mechanisms with potential to predict and improve treatment outcomes for veterans with PTSD/SUD. We hypothesized that PTSD symptom severity would be related to (a) alcohol use severity and (b) drug use severity through DI and AS, evaluated concurrently. Participants included 120 military veterans (98.3% male; Mage = 41.41, SD = 10.77) presenting for psychological services at a Veterans Affairs PTSD/SUD clinic. Results indicated that PTSD symptom severity was related to alcohol use severity through AS, but not DI; and PTSD symptom severity was related to drug use severity through DI, but not AS. Clinical and research implications are discussed.

The mediating role of personalized psychological flexibility in the association between distress intolerance and psychological distress: A national survey during the fourth waves of COVID-19 pandemic in Iran.

The global COVID‐19 outbreak has put the human race's distress tolerance abilities to the test. And, the distress experienced getting worse with each pandemic wave; however, the more flexible the person, the greater the chance of surviving. Thus, the current study aimed to examine the mediating role of personalized psychological flexibility (PPF) in the link between distress intolerance to psychological distress during the fourth wave of the pandemic in Iran. A total of 576 individuals (Meanage 34.80, ±10.9, females 55.6%) took part in the online survey. In this national sample, PPF partially played a role in mediating the association mentioned above. Interestingly, this mediation was independent of demographic factors (age, gender, marital status, and educational level) and fear of COVID‐19, mindfulness, and satisfaction with life. So, despite the mentioned variables, accepting and using unpleasant emotions as fuel to achieve valued goals rather than avoiding them would mitigate the psychological distress during the pandemic. Consequently, public health services can aim to provide psychological flexibility enhancing interventions to decay COVID‐19‐related mental distress.

Severity of personality dysfunction predicts affect and self-efficacy in daily life.

According to the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) alterative model of personality disorders, severity of personality dysfunction theoretically involves deficits in identity, self-direction, empathy, and intimacy. We predicted that people with greater personality dysfunction would experience more problems in daily life, particularly problems associated with self-efficacy for engaging with affect and self-control (i.e., subjective willpower and distress intolerance), along with greater intensity of life stressors and higher perceived invalidation from others. Using ecological momentary assessment, participants (N = 99) were randomly prompted 7 times a day for 1 week, where they were asked questions about momentary affect, their perceived level of momentary distress tolerance, and their momentary willpower. Each night they were also asked about stressors experienced that day and intensity of their subjective response to those stressors and their daily experience of being invalidated. Results found that higher personality dysfunction, assessed at baseline, predicted greater daily negative affect, less daily positive affect, more intensely experienced stressors, and more perceived invalidation. We also found that personality dysfunction interacted with positive affect in predicting momentary self-efficacy and daily invalidation; people with greater personality dysfunction experienced lower momentary willpower, higher distress intolerance and stronger perceived invalidation alongside lower positive affect. These findings provide evidence that personality functioning influences daily life as well as support the use of the alterative model of personality disorders in conceptualizing personality pathology. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Intolerance of uncertainty and distress in women with delayed IVF treatment due to the COVID-19 pandemic: The mediating role of situation appraisal and coping strategies.

The COVID-19 pandemic has caused delays of numerous medical procedures, including IVF. This study investigates the relationship between Intolerance of Uncertainty (IU), situation appraisal-the perceived threat that COVID-19 poses for infertility treatment, coping strategies, and general distress among women with a delayed IVF procedure. SEM showed that situation appraisal is a partial mediator of the relationship between IU and avoidance, as well as the relationship between IU and general distress. The connection between situation appraisal and general distress is partially mediated by avoidance. In this challenging context for mental health, situation appraisal and coping strategies determine the level of distress, where IU, as a dispositional variable, represents the main determinant of the entire reaction.

Anxiety sensitivity, distress intolerance, and negative interpretation bias strengthen the relationship between trait anxiety and depersonalization

ABSTRACT Background and Objectives Depersonalization is common in anxiety disorders, but little is known about factors that influence co-occurring anxiety and depersonalization. Design We investigated trait moderators of the relationships between state and trait anxiety and depersonalization to better understand their co-occurrence and to identify potential points of intervention. Methods Adults recruited on Amazon Mechanical Turk (N = 303) completed two computer tasks designed to increase variability in state anxiety and depersonalization as well as several self-report questionnaires. Results As hypothesized, anxiety positively predicted depersonalization at both a state level and trait level. Moreover, as hypothesized, the trait anxiety-trait depersonalization relationship was strengthened by greater anxiety sensitivity; distress intolerance; and negative interpretation bias for anxiety sensations, and for depersonalization sensations. None of these hypothesized trait moderators significantly strengthened the state anxiety-state depersonalization relationship. Conclusions These findings suggest that, on a trait level, anxiety and depersonalization more frequently co-occur when people catastrophically misinterpret their symptoms or have lower emotional distress tolerance.

Cognitive control training for urgency: A pilot randomized controlled trial in an acute clinical sample

Urgency – rash action in the context of strong emotion – is a facet of impulsivity closely related to many psychological disorders. Deficits in working memory and response inhibition are potential mechanisms underlying urgency, and a previous study showed that cognitive training targeting these domains is efficacious in reducing urgency. However, the feasibility and efficacy of this intervention has not yet been tested in a clinical sample or naturalistic treatment setting. To fill this gap, we conducted a pilot study of cognitive training for individuals reporting high levels of urgency in a partial hospitalization program. We evaluated this intervention in an open trial (n = 20), followed by a randomized controlled trial (n = 46) comparing cognitive training plus treatment as usual to treatment as usual. Results supported the feasibility and acceptability of cognitive training. Participants in the training group showed significant improvement on cognitive tasks, but groups did not differ in urgency. In pooled analyses combining the open trial and RCT, there was a significant reduction in distress intolerance in the training group only. Results indicate the potential benefit of cognitive training for distress intolerance, but do not support the use of cognitive training for urgency in acute clinical settings.The study conducted in the RCT phase of this manuscript is registered on ClinicalTrials.gov (NCT: NCT03527550). The full trial protocol is available on ClinicalTrials.gov.